Chii chinonzi Restenosis?

Zvemukati

• Mhedziso
• In-stent restenosis (ISR)
• Zviratidzo zve restenosis
• Zvinokonzera restenosis
• Nguva yekuti restenosis iitike
• Kuongororwa kwe restenosis
• Kurapa kwe restenosis
• Maonero uye kudzivirira restenosis

Mhedziso

Stenosis inoreva kudzikira kana kuvhara kwetsinga nekuda kwekuvakwa kwechinhu chine mafuta chinonzi plaque (atherosclerosis). Kana zvikaitika mumitsipa yemoyo (coronary arteries), inonzi coronary artery stenosis.

Restenosis (“re” + “stenosis”) ndipo apo chikamu chetsinga yaimborapwa kuvharika chinova chakamanikana zvakare.

In-stent restenosis (ISR)

Angioplasty, rudzi rwekupindirana kwecoronary kupindira (PCI), inzira inoshandiswa kuvhura tsinga dzakadzivirirwa. Munguva yekuita izvi, kadiki simbi scaffold, inonzi moyo stent, inowanzo garoiswa mutsinga umo yakavhurwa. Iyo stent inobatsira kuti arteri izarurike.

Kana chikamu chetsinga ine stent yakavharwa, inonzi in-stent restenosis (ISR).

Kana ropa rakagwamba, kana thrombus, rikaumbika muchikamu chetsinga ine stent, inonzi in-stent thrombosis (IST).

Zviratidzo zve restenosis

Restenosis, iine kana isina stent, inoitika zvishoma nezvishoma. Izvo hazvizokonzere zviratidzo kudzamara iko kuvharirwa kwakaipa zvakakwana kuchengetedza moyo kuti usatore hushoma huwandu hweropa hwaunoda.

Kana zviratidzo zvikavapo, zvinowanzo fanika nezviratidzo zvekuvharirwa kwekutanga kusati kwagadziriswa. Kazhinji izvi ndizvo zviratidzo zvecoronary arteri chirwere (CAD), senge kurwadziwa kwepfupa (angina) uye kupfupika kwemweya wekufema.

IST inowanzo kukonzera kamwe kamwe uye zvakakomba zviratidzo. Iro clot rinowanzo vharira tsinga dzese dzekoniyoni, saka hapana ropa rinogona kusvika pachikamu chemwoyo charinopa, zvichikonzera chirwere chemwoyo (myocardial infarction).

Kunze kwezviratidzo zvekurwadziwa kwemoyo, panogona kuve nezviratidzo zvezvinetso sekutadza kwemoyo.

Zvinokonzera restenosis

Balloon angioplasty ndiyo nzira inoshandiswa kurapa coronary stenosis. Inosanganisira kukanda catheter muchikamu chakamanikana checoronary arteri. Kuwedzera chibharumu chiri pamuromo wekateti kunosundira chikwangwani kudivi, kuvhura tsinga.

Maitiro acho anokuvadza madziro etsinga. Nyama nyowani inokura mumadziro akakuvara sezvo tsinga inopora. Pakupedzisira, lining nyowani yemasero ane hutano, inonzi endothelium, inovhara saiti.

Restenosis inoitika nekuti iyo yakasununguka arteri madziro anowanzo dzokera zvishoma nezvishoma mukati mushure mekutambanudzwa kuvhurika. Zvakare, tsinga yacho inoderera kana kukura kwetishu panguva yekurapa kwakanyanyisa.

Bare simbi stents (BMS) yakagadziridzwa kubatsira kurwisa iyo yakavhurika tsinga yetsika yekuvhara uchirapa.

Iyo BMS inoiswa padivi peiyo artery madziro apo iro bharumu rinofutirwa panguva yeangioplasty. Iyo inodzivirira madziro kuti asadzokere mukati, asi nyowani nyowani kukura inoramba ichingoitika mukupindura kukuvara. Kana nyama dzakawandisa dzichikura, tsinga inotanga kutetepa, uye restenosis inogona kuitika.

Drug-eluting stents (DES) ikozvino ndiyo inowanzoshandiswa stents. Ivo vakadzora zvakanyanya dambudziko re restenosis, sekuonekwa nemitero ye restenosis inowanikwa mune chinyorwa cha2009 chakaburitswa muAmerican Family Chiremba:

• balloon angioplasty isina stent: 40 muzana yevarwere vakagadzira restenosis
• BMS: 30 muzana yakagadzira restenosis
• DES: pasi pegumi muzana yakagadziriswa restenosis

Atherosclerosis inogona zvakare kukonzera restenosis. A DES inobatsira kudzivirira restenosis nekuda kwekukura kwemasuru matsva, asi haina kukanganisa mamiriro ezvinhu akakonzera stenosis pakutanga.

Kunze kwekunge zvinhu zvako zvine njodzi zvachinja mushure mekuisa stent, chikwangwani chinoramba chichiwedzera mune yako coronary artery, kusanganisira mune stents, izvo zvinogona kutungamira kuzorora

Iyo thrombosis, kana ropa clot, inogona kuumbika kana zvinhu zvinogwamba muropa zvikasangana nechimwe chinhu chisingazivikanwe nemuviri, senge stent. Neraki, maererano neiyo, IST inokura mune chete chikamu chimwe muzana muzana checoronary arteri stents.

Nguva yekuti restenosis iitike

Restenosis, iine kana isina stent kuiswa, inowanzo kuratidza pakati pemwedzi mitatu nemitanhatu mushure mekuvhurwa kwetsinga. Mushure megore rekutanga, njodzi yekuvandudza restenosis kubva mukukura kwemasuru kukura ishoma kwazvo.

Restenosis kubva pasi peCAD inotora nguva yakareba kuti ikure, uye kazhinji inoitika gore kana kupfuura mushure mekurapwa kwepakutanga stenosis. Ngozi ye restenosis inoenderera kusvikira izvo njodzi zvehosha yemoyo zvadzikira.

Zvinoenderana neiyo, mazhinji maISTs anoitika mumwedzi yekutanga mushure mekuiswa stent, asi kune diki, asi yakakosha, njodzi mukati megore rekutanga. Kutora vanocheka ropa kunogona kuderedza njodzi yeIT.

Kuongororwa kwe restenosis

Kana chiremba wako achifungidzira restenosis, ivo vanowanzo shandisa imwe yeitatu bvunzo. Aya maedzo anobatsira kuwana ruzivo nezve iyo nzvimbo, saizi, uye mamwe maitiro evhavha. Vari:

• Coronary angiogram. Dhayi inopindwa muropa kuti iratidze kuvharika uye kuratidza kuti ropa rinoyerera zvakadii paX-ray.
• Intravascular ultrasound. Mafungu ezwi anoburitswa kubva pane catheter kuti agadzire mufananidzo wezve mukati tsinga.
• Optical kuwirirana tomography. Masaisai emwenje anoburitswa kubva pane catheter kuti agadzire yakakwira-resolution mifananidzo yemukati meateri.

Kurapa kwe restenosis

Restenosis isingakonzere zviratidzo kazhinji haidi chero kurapwa.

Kana zviratidzo zvikaonekwa, zvinowanzo nyanyisa, saka pane nguva yekurapa restenosis tsinga isati yavhara zvachose uye inokonzeresa kurwara kwemoyo.

Restenosis mune tsinga isina stent inowanzo kurapwa nebhaluni angioplasty uye DES kuiswa.

ISR inowanzo kurapwa nekuiswa kweimwe stent (kazhinji DES) kana angioplasty uchishandisa chibharumu. Bhaluni rakaputirwa nemishonga inoshandiswa paDES kutadzisa kukura kwetishu.

Kana restenosis ichiramba ichiitika, chiremba wako anogona kufunga nezvecoronary arteri kuburikidza nekuvhiya (CABG) kudzivirira kuisa akawanda stents.

Dzimwe nguva, kana iwe ukasarudza kusava nehurongwa kana kuvhiyiwa kana kuti ukasazvitsungirira zvakanaka, zviratidzo zvako zvinorapwa nemushonga wega.

IST inenge iri nguva dzose yekukurumidzira. Kusvika makumi mana muzana yevanhu vane IST havaipone. Kubva pane zviratidzo, kurapwa kweangina isina kugadzikana kana chirwere chemwoyo chinotanga. Kazhinji PCI inoitwa kuyedza kuvhurazve tsinga nekukurumidza uye kuderedza kukuvara kwemoyo.

Zviri nani kudzivirira IST pane kuyedza kuchirapa. Ndokusaka, pamwe neasipurini yezuva nezuva yehupenyu, iwe ungagamuchire vamwe vanoonda ropa, senge clopidogrel (Plavix), prasugrel (Effient), kana ticagrelor (Brilinta).

Aya anoderera eropa anowanzo kutorwa kwemwedzi mumwe chete, asi kazhinji kwegore rimwe chete kana anopfuura, mushure mekuisirwa stent.

Maonero uye kudzivirira restenosis

Tekinoroji yazvino yaita kuti zvinyanye kushomeka kuti uve ne restenosis kubva pakuwandisa kwetissue mushure meangioplasty kana kuiswa kwakasimba.

Kudzoka zvishoma nezvishoma kwezviratidzo zvawaive nazvo pamberi pekuvharika kwekutanga mutsinga chiratidzo chekuti restenosis iri kuitika, uye unofanirwa kuona chiremba wako.

Iko hakuna zvakawanda zvaungaite kudzivirira restenosis nekuda kwekuwandisa kwemasuru kukura panguva yekurapa. Nekudaro, iwe unogona kubatsira kudzivirira restenosis nekuda kwechikonzero checoronary artery chirwere.

Edza kuchengetedza mararamiro ane hutano pamoyo anosanganisira kusasvuta, kudya zvine hutano, uye kurovedza muviri zvine mwero. Izvi zvinogona kudzikisa njodzi yekuvakwa kweplate mumatope ako.

Iwe zvakare haufarire kuwana IST, kunyanya mushure mekunge iwe uine stent kwemwedzi mumwe kana kupfuura. Kusiyana neISR, zvakadaro, IST inowanzo kuve yakakomba uye inowanzo kukonzera zviratidzo zvenguva pfupi zvekurwadziwa kwemoyo.

Ndosaka kudzivirira IST nekutora vanocheka ropa kwenguva yakareba sekurudzirwa nachiremba wako kwakanyanya kukosha.